Healthcare Provider Details

I. General information

NPI: 1265655153
Provider Name (Legal Business Name): BABAC VAHABZADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 RIDGEGATE PKWY SUITE 312
LONE TREE CO
80124-5520
US

IV. Provider business mailing address

10103 RIDGEGATE PKWY SUITE 312
LONE TREE CO
80124-5520
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-8888
  • Fax: 866-456-4594
Mailing address:
  • Phone: 303-788-8888
  • Fax: 866-456-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0052202
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-33302
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2005018189
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD48449
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: